Failed Payment Form (Academy)

Failed Payment Form
Have you received a Failed Payment or Overdue Direct Debit Payment(s) notice from us?

Don't worry, we understand that these things happen from time to time.

You can use this form to settle your failed payment by credit card.

Please only use this form to settle failed payments.

Late Payment Fees covering administration will be deducted from any amount paid.

Please use our Upfront Deposit Form to make a deposit on your current membership.
Account Holder Name

First NameLast Name
Paying For
Their Name

First NameLast Name
Training Location
Please specify your training location
Email Address
example@example.com
Failed Payment Amount
This must match the amount shown on your notice
Please ensure that your Failed Payment Amount includes any Late Payment Fee(s).

This fee helps us cover some of the costs we incur from failed payments and allows us to keep our membership fees as affordable as possible.

We will deduct your Late Payment Fee(s) (as specified in your Payment Agreement) from your ${failedPayment} payment and credit the remainder to your membership balance.

Your account will remain in arrears until you pay all failed payments and late payment fees.
Payment Calculation
Secure Payment

Your payment will be securely processed by Stripe Payments

Amount to Pay Now

AUD

Payment Methods
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Amount ex. GST
GST
Amount Paid
Stripe Description
Failed Payment Terms and Conditions
1. Payments made through this form are non-refundable and non-transferable.
2. Under your Payment Agreement (or Direct Debit Agreement), a late payment fee is payable to the Academy for each failed payment. This fee helps us cover some of the administrative costs and transaction fees associated with handling failed payments. Our direct debit provider, EziDebit, and your bank may also charge you dishonour fees.
3. If your bank account details have changed, please email administration@wingchun.edu.au immediately with your updated details to avoid incurring further failed payments, late payment and dishonour fees.
4. If you do not want future payments to be debited to your bank account, you can make an upfront deposit with your credit card through our Upfront Deposit Form.
5. If you are experiencing financial difficulties, you may wish to suspend your membership. You must settle all failed payments before requesting a suspension.
A tax invoice for your payment will be emailed to you.

By clicking 'Submit' below, you represent that you understand and accept these Terms and Conditions.
Form not working? Relaunch in a new window.
Should be Empty: